Camp Jubilee Counselor Application

Name*

First Last

T-Shirt Size*

Gender*

Age*

Birthdate*

Address*

Street Address City State ZIP Code

Email*

Primary Phone*

Secondary Phone*

Camp Experience*

List and describe any church/mission work experience. List any training or experience that has prepared you for working with campers with special needs.

Areas of Service

It is expected that teenage and young adult volunteers serve as counselors.

Please select your preference of service.*

Insurance Information

Provider*

Policy Number*

Primary Subscriber*

Group Number*

Effective Date*

Medical Information

Emergency Contact*

Primary Phone*

Secondary Phone*

Relationship*

Are you in good health?*

Yes
No

If no, please explain.

Do you have any physical limitations that would determine your activity as a staff person?*

Yes
No

If yes, please explain:

Do you have any allergies?*

Yes
No

If yes, please explain:

Do you use an Epi Pen?

Yes
No

Do you take any regular medications?*

Yes
No

If yes, list all medications:

Any known communicable diseases? (HIV/AIDS, Hepatitis Type, Other) If this information is not included, in case of emergency safety protocol will be followed)*

Background Information

Have you ever been convicted of any criminal offense other than a minor traffic violation?*

Yes
No

If yes, please explain:

Have you ever been charged with child abuse or a crime involving actual or admitted sexual molestation?*

Yes
No

If yes, please explain:

Background Acknowledgement

Background Check Permissions

I give permission for MJM to complete a background check.
I am under 18 and exempt from the background check.

Authorized Signature (if applicant is over 18)

Typing your name will be treated as your signature and is binding!

Social Security Number

A Social Security number is required for the background check.

Permissions

Permissions:*

Select All
I give permission to be checked for lice.
I give permission to receive any medical treatment necessary for their health and well-being.
I give permission to be transported by MJM staff and/or volunteers for medical emergencies.
I give permission to be included in photos that may be used for marketing.

NOTE: Typing your name will be treated as your signature and is binding!

Authorized Signature (if applicant is under 18 a parent/guardian must sign)

Applicant Signature (if applicant is over 18)

Date*

Dress Code & Restrictions

Each MJM volunteers will adhere to a modest dress code which will be monitored by the Sr. staff. We appreciate you honoring God and our campers in how you dress.
• It is expected that modest attire should be worn throughout the camp (a modest one-piece swimsuit, loose fitting t-shirts that cover midriffs, no spaghetti straps, no tight-fitting or low-hanging pants or shorts, no short shorts or miniskirts.)
• No tobacco, alcohol, illegal drugs, vape, smokeless devices, weapons of any kind.
• Cell phone use should be limited to emergency contacts only.

Signature*

I am willing to follow the rules of Camp Jubilee as they may affect my dress, conduct, personal habits, etc. and to submit to the leadership of Camp Jubilee staff and the Director. NOTE: Typing your name will be treated as your signature and is binding!

Personal Information

Church Affiliation*

Elder/Pastor*

Elder/Pastor's Phone*

Elder/Pastor's Email*

Please list two personal references and include complete contact information. (not a relative - i.e.: friend, co-worker, teacher) PLEASE NOTE! NO counselor applications will be considered without this complete information

Name*

First Last

Phone*

Relationship*

Email*

Name*

First Last

Phone*

Relationship*

Email*

Testimony (for new applicants only)

Describe your personal relationship with Jesus Christ. Also, please write WHY you want to serve on staff at Camp Jubilee.

Testimony

Doctrinal Statement of Faith of Mount Jubilee Ministries

The following Biblical truths shape the foundation for the teaching and operation of Mount Jubilee Ministries. All who take an active role in the ministry are expected to agree with and uphold them. 1. The Bible is the inspired Word of God, inerrant in its original manuscripts and the final authority in all matters of faith and practice. (II Timothy 3:16 & 17) 2. There is one God, eternally co-existing in three distinct persons: Father, Son and Holy Spirit. (I Peter 1:2) 3. The Lord Jesus Christ is fully God and became fully man. Through His virgin birth, by His death and resurrection, the Lord Jesus Christ made salvation a free gift to all who receive Him. (John 3:16 & 36; Ephesians 2:8 & 9) 4. Each member of the human race is created in the image of God, but falls short of God’s glorious standard, sinful and lost. Regeneration by the Holy Spirit is absolutely essential for the salvation of each individual. Redemption is wholly by the blood of Christ, and salvation is by grace, through faith in our Lord Jesus Christ. (Romans 3:10 – 30) 5. God created and maintains all things by His sovereign power. (Colossians 1: 15 – 17) 6. The Church of our Lord Jesus Christ is composed of all true believers in the Lord Jesus Christ. True believers have assurance of eternal life and the power of the Holy Spirit to live righteous lives. (John 10: 27 - 29; Galatians 5:16 - 18) 7. The blessed hope of the Church is the personal and imminent return of the Lord: the saved to enjoy eternal bliss and the unsaved to experience eternal and conscious punishment. (Revelation 20: 11 – 15)

Do you agree with the MJM statement of faith?*

Yes
No

If no, please explain:

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Personal & Church References

Please list two personal references and include complete contact information. (not a relative - i.e.: friend, co-worker, teacher) Please also list one leader from your local church as a reference and include complete contact information. PLEASE NOTE! NO counselor applications will be considered without this complete information.

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Waiver and release of Liability

In consideration of being allowed to volunteer my services for Mount Jubilee Ministries, Inc. (MJM) and Camp Jubilee, I hereby acknowledge that there are certain risks of injury involved, and I knowingly and freely assume all such risks and assume full responsibility for my participation. To the extent allowed by law, I agree to indemnify and hold harmless Mount Jubilee Ministries, Inc., its officers, employees, agents, representatives and volunteers, of all liabilities and all loss or damage to person or property which may occur or be incident to my involvement or participation.

Volunteer Confidentiality Agreement

I recognize that as a volunteer of Mount Jubilee Ministries, Inc. (MJM), a North Carolina non-profit corporation, I may have access to confidential information concerning MJM, its guests, agents, employees, volunteers or representatives. In consideration of any volunteer status with MJM, I agree I will not at any time, during or after volunteering for MJM, divulge or reveal to any person, firm or corporation, any information (including, but not limited to, personal or financial information or camper and family lists), directly or indirectly, which might in any way be used to injure or interfere with the business or ministry of MJM, or to alienate guests, agents, employees, volunteers or representatives from MJM or to cause discontent or dissatisfaction among any such persons. I agree that should I have any questions as to the propriety of release of any information, I will request clearance from MJM prior to releasing such information. By signing my name below, I am showing that I agree with the statements contained on this page.

Signature*

Date*

By signing my name above, I am showing that I agree with the statements contained on this page.

NOTE: Typing your name will be treated as your signature and is binding!

Contact Information

For further information or questions contact:
Candice Hughes, Camp Director (336) 951-9929
or Jenna Moore, MJM Program Director 336-520-0260

Join the Camp Jubilee Crew!

Areas of Service

Insurance Information

Medical Information

Background Information

Background Acknowledgement

Permissions

Dress Code & Restrictions

Personal Information

Testimony (for new applicants only)

Doctrinal Statement of Faith of Mount Jubilee Ministries

Personal & Church References

Waiver and release of Liability

Volunteer Confidentiality Agreement

Mount Jubilee Ministries

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